Concussion Treatment and Rehabilitation: What You Need to Know
Concussions are one of the most misunderstood injuries in sport and everyday life. They're invisible on imaging, variable in presentation, and surrounded by outdated advice that can actually slow recovery. Here's what current evidence actually recommends.
First: What Is a Concussion?
A concussion is a functional brain injury, not a structural one. It doesn't require a direct blow to the head, a hit to the body that causes the brain to move rapidly within the skull is enough. Symptoms can include headache, brain fog, light and noise sensitivity, sleep disturbance, emotional changes, dizziness, and difficulty concentrating. It is important to note that a loss of consciousness occurs in only a small minority of cases and is not required for a concussion diagnosis.
When in doubt, sit it out. Any athlete suspected of having a concussion should be removed from play immediately and not return the same day, regardless of how they feel.
The Old Advice Was Wrong
For years, complete rest in a dark room was the standard recommendation. Current evidence has moved away from this significantly. Prolonged rest beyond the first 24–48 hours has been shown to worsen and prolong symptoms. Relative rest in the immediate period following injury is appropriate, but early, gradual reintroduction of activity leads to better outcomes.
What Actually Helps
Sub-symptom aerobic exercise. Controlled aerobic activity like light walking or stationary cycling introduced within the first few days has strong evidence behind it. The goal is to elevate heart rate without worsening symptoms. This approach has been shown to accelerate recovery and reduce the risk of prolonged symptoms.
Sleep and routine. Protecting sleep quality and maintaining a consistent daily routine supports neurological recovery. Avoid screens, alcohol, and other stimulants in the early phase.
Gradual return to activity. Hockey Canada's Return-to-Sport protocol follows a stepwise progression, from rest, to light aerobic exercise, to sport-specific activity, to non-contact drills, to full contact practice, and finally return to competition. Each step requires a minimum of 24 hours and should only advance if the previous step is symptom-free.
Multidisciplinary care for prolonged symptoms. When symptoms persist beyond 4 weeks, sometimes called Post-Concussion Syndrome, a multidisciplinary approach is recommended. This may include vestibular rehabilitation for dizziness and balance, cervical spine treatment for neck-related headache, vision therapy, and psychological support for mood and anxiety symptoms. Research increasingly shows that targeted, symptom-specific treatment outperforms rest alone in this population.
When to Seek Emergency Care
Go to the emergency room immediately if you or someone you know experiences a concussion with: one pupil larger than the other, repeated vomiting, seizures, worsening headache, loss of consciousness, significant drowsiness, or a deteriorating level of awareness. These may indicate a more serious brain injury.
The Takeaway
Concussions are serious, but with the right management, most people recover fully. The key is recognizing the injury early, avoiding the urge to push through, and following a structured, evidence-based return to activity. Sitting out one game is always worth it.
This post is intended for general educational purposes and does not constitute medical advice. If you suspect a concussion, please seek evaluation from a qualified healthcare provider before returning to any activity.